CAJ | 학술논문

目的探讨高通量血液透析(HFHD)在不同超滤量时对尿毒症毒素清除的影响以及与低通量血液透析(LFHD)和血液透析滤过(HDF)清除效果比较.方法从本院在透200多例维持性血液透析患者中选取符合入选标准75例,随机分成5组(HFHD2L组,HFHD4L组,HFHD6L组,LFHD组,HDF组),每组15例.于透析上、下机前抽取静脉血送检小分子尿毒症毒素(简称小分子毒素,以下相同,包括UREA,Cr和P)、大分子尿毒症毒素(简称中大分子毒素,包括Hcy,β2-MG和iPTH)和血浆蛋白质(包括ALB和CRP)等,并计算各自的下降率.同时,留取透析液做细菌培养和内毒素检测,记录患者透析时出现的并发症.结果五种透析方式对小中大分子尿毒素及血浆蛋白质的清除(下降率)比较:小分子毒素＞中大分子毒素,差异有非常显著性意义(P＜0.01),对血浆蛋白质没有清除(下降率为负值).组间比较:LFHD、HF-HD、HDF对小分子毒素的清除(下降率)达60％以上,三者之间差异无统计学意义(P＞0.05);对中大分子毒素的清除(下降率)存在较大的区别,HDF＞ HFHD＞ LFHD.HFHD组三组内比较:中大分子毒素清除(下降率)随透析超滤量的增加呈下降趋势,但是这种差异无统计学意义(P＞0.05).不良反应以LFHD发生病例数最多.HFHD和HDF病例数区别不大.结论 HFHD治疗优势主要在于对中大分子毒素的清除明显优于LFHD,稍逊于HDF.但其价格低廉,经济实惠,可长期使用.对中大分子毒素的清除也不必刻意的通过增加透析超滤量来提高透析器的清除率.注意超纯透析用水和透析液的应用.
목적 탐토고통량혈액투석(HFHD)재불동초려량시대뇨독증독소청제적영향이급여저통량혈액투석(LFHD)화혈액투석려과(HDF)청제효과비교.방법 종본원재투200다례유지성혈액투석환자중선취부합입선표준75례,수궤분성5조(HFHD2L조,HFHD4L조,HFHD6L조,LFHD조,HDF조),매조15례.우투석상、하궤전추취정맥혈송검소분자뇨독증독소(간칭소분자독소,이하상동,포괄UREA,Cr화P)、대분자뇨독증독소(간칭중대분자독소,포괄Hcy,β2-MG화iPTH)화혈장단백질(포괄ALB화CRP)등,병계산각자적하강솔.동시,류취투석액주세균배양화내독소검측,기록환자투석시출현적병발증.결과 오충투석방식대소중대분자뇨독소급혈장단백질적청제(하강솔)비교:소분자독소＞중대분자독소,차이유비상현저성의의(P＜0.01),대혈장단백질몰유청제(하강솔위부치).조간비교:LFHD、HF-HD、HDF대소분자독소적청제(하강솔)체60％이상,삼자지간차이무통계학의의(P＞0.05);대중대분자독소적청제(하강솔)존재교대적구별,HDF＞ HFHD＞ LFHD.HFHD조삼조내비교:중대분자독소청제(하강솔)수투석초려량적증가정하강추세,단시저충차이무통계학의의(P＞0.05).불량반응이LFHD발생병례수최다.HFHD화HDF병례수구별불대.결론 HFHD치료우세주요재우대중대분자독소적청제명현우우LFHD,초손우HDF.단기개격저렴,경제실혜,가장기사용.대중대분자독소적청제야불필각의적통과증가투석초려량래제고투석기적청제솔.주의초순투석용수화투석액적응용.
Objectives To investigate the impact of removing uremic toxins in different ultrafiltration in patients treated with HFHD comparing with LFHD and HDF.Methods 75 cases from more than 200 uremic patients in MHD were randomized to assign five groups (HFHD2L,HFHD4L,HFHD6L,LFHD,HDF),each group includes 15 cases.Lower Molecular Weight (LMW,include:Urea,Cr,P),Middle and High molecular Weight (MHMW,include:Hcy,β2-MG,iPTH),Plasma Proteins (PP,include:ALB,CRP) in blood plasma were measured before and after dialysis,Bacterial cultures and Endotoxin concentrations were checked in dialysis fluid and dialysis water,and side-effects happened in patients during dialysis were recorded at the same time.Results After the dialysis procedure,no significant changes were found for solute reduction ratio of LMW and lower clearance of PP,But there are very high different in MHMW between the five groups.The removal of MHMW increased in HF-HD groups which the percentage change of SRR of MHMW were inversely decreased by increasing ultraqltration during dialysis,there were very significantly greater than LFHD and significantly lower than HDF(P ＜ 0.05).Conclusions HFHD is a better style of hemodialysis for the patients in MHD.The major advantage of HFHD has more removal of MHMW than LFHD and dont need to improve the clearance of MHMW by increasing uhrafiltration during dialysis.It's also very cheaper,better practice than HDF.Use of ultrapure dialysis water and dialyate is the key of reducing inflammation and comorbidities of patients treated with HFHD.